Latin American feminists address obstetrical violence

Term encompasses all forms of abuse during pregnancy, childbirth, and postpartum

Obstetrical violence is a term that describes physical, verbal, or psychological abuse during pregnancy, childbirth, and postpartum, as well as behaviors or practices that are outdated or not based on scientific evidence carried out by health personnel. It can cause impairment of maternal and neonatal health. Included in this is the lack of informed consent, inadequate information, derogatory treatment, and unjustified use of c-sections or episiotomies. In Latin America, it’s a serious issue and has galvanized feminists to address this manifestation of gender violence and discrimination. I corresponded with Romina Gallardo, co-founder of Gestar Derechos, an interdisciplinary group that provides legal advice and support to women who suffered obstetrical violence, about how common it is in that part of the world. 

What is the conventional experience of a woman in Latin America who endures obstetrical violence? How does it resolve itself? 

Speaking of the case of Uruguay, the majority of women who currently suffer obstetric violence can recognize it, name it and share their experiences, in part thanks to the efforts of activist groups that give voice to this problem, although it is still a very naturalized and justified type of violence by the rest of society, especially because of the place of prestige that the medical community still holds. The solution is far from being achieved since a large part of health teams refuse to recognize its existence, minimize it or reduce it to examples of isolated behaviors. 

Is there any legal recourse to obstetrical violence?  

Both in Uruguay and in the rest of Latin America, obstetric violence has been recognized by the laws of the various countries. It can mostly be reported through administrative means, with therefore administrative sanctions, for example observations or recommendations. In general, civil proceedings are used to claim medical responsibility or Medical Ethics Courts, even if they involve cases of obstetric violence. In short, these cases do not have their own legal procedure, at least not in Uruguay. 

How widespread is this? Do you have any statistics on the incidence of obstetrical violence? In what countries is this most problematic?

Although there is no data to establish how widespread obstetric violence is in Latin America, or which country is the most affected, those of us who work on these issues understand that it has a high prevalence. During the Covid-19 pandemic, various practices of obstetric violence were reported throughout the continent, including in the United States. Countries like Spain or Portugal are also not immune to the phenomenon. It is possible to affirm that it is a problem that transcends continents, in that sense the study by Bohren et al (2015) is very complete documenting this problem worldwide. On the other hand, the high rates of cesarean sections throughout Latin America clearly speak to us of a high degree of interventionism and medicalization of childbirth, there is concrete data. 

Is there a culture of violence created in these countries? Is this condoned in any way by leaders or by hospital officials? 

I think that, for example, in Uruguay, we can maintain that there is a notorious problem in relation to gender violence, just look at the figures of femicides each year and the lack of response from the Uruguayan State to the issue. For the government leaders, it is frankly not an issue that is on the agenda, although the current government in some way intends to promote the birth rate that is declining in Uruguay, on the other hand it does not take any type of action on this problem that affects women who want to carry out a pregnancy. On the other hand, the health services authorities do not take on this problem either, and from the Ministry of Public Health, which receives this type of complaints, we find that the cases have a wait for resolution of at least two years, so we return to the same thing, the lack of public policies to address it. 

What have Latin American governments done to address this? 

From what I can observe from my work on this topic for several years and the contact I maintain with activists and academics from Latin America and Europe, beyond legislating on the subject, little has been done by governments with concrete actions. 

What are feminist groups doing to advocate on this issue? 

Feminist groups, such as Gestar Derechos and many others, are the banner that keeps women's voices alive in relation to obstetric violence, insisting that this problem exists and must be addressed urgently, as well as groups that advocate for the humanization of childbirth and rescue its physiology. Although sometimes there may be differences between these groups, regarding how we understand the rights around birth, in general we want the same thing, births free of all types of coercion, in which people are the center. 

Is there anything else you'd like to say about the issue?

Let us not forget the transcendental importance of a birth, and how a bad experience or incorrect intervention can affect a pregnant person or a baby for life.